抗高血糖药物与心血管结局：最新见解
Antihyperglycemic agents and cardiovascular outcomes: recent insights.
作者信息
Bajaj Harpreet S, Zinman Bernard, Verma Subodh
机构信息
aLMC Diabetes & Endocrinology, Brampton bLeadership Sinai Centre for Diabetes cLunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto dDivision of Endocrinology and Metabolism, University of Toronto eDivision of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital fDivision of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
出版信息
Curr Opin Cardiol. 2017 Sep;32(5):642-650. doi: 10.1097/HCO.0000000000000435.
PURPOSE OF REVIEW
To summarize cardiovascular outcome trials (CVOTs) with antihyperglycemic agents conducted since 2008 US Food and Drug Administration guidance.
RECENT FINDINGS
A series of large CVOTs since 2008 have included patients with type 2 diabetes (T2D), who are otherwise treated according to standard of care. After the initial trials with incretin agents demonstrated cardiovascular safety, two recent CVOTs with currently available antihyperglycemic agents - EMPA-REG OUTCOME with empagliflozin and LEADER with liraglutide - show a significant reduction of the primary composite outcome, including a significant difference in the cardiovascular death end-point in both trials [EMPA-REG OUTCOME: hazard ratio = 0.62, confidence interval (CI) = 0.49-0.77, P < 0.001 and LEADER: hazard ratio = 0.78, CI = 0.66-0.93, P = 0.007]. Number needed to treat to prevent one cardiovascular death of 46 and 77 for empagliflozin and liraglutide, respectively, over 3 years is comparable with other currently employed evidence-based cardioprotective strategies. In addition, EMPA-REG OUTCOME trial had a robust reduction in hospitalization for heart failure (hazard ratio = 0.65, CI = 0.50-0.85, P = 0.002).
SUMMARY
New-generation CVOTs are shifting the focus in the treatment of T2D to the prevention of cardiovascular morbidity and mortality.
综述目的
总结自2008年美国食品药品监督管理局发布指南以来开展的使用降糖药物的心血管结局试验（CVOTs）。
最新发现
自2008年以来的一系列大型CVOTs纳入了2型糖尿病（T2D）患者，这些患者均按照标准治疗方案进行其他治疗。在最初使用肠促胰岛素药物的试验证明心血管安全性之后，最近两项使用现有降糖药物的CVOTs——恩格列净的EMPA-REG OUTCOME试验和利拉鲁肽的LEADER试验——显示主要复合结局显著降低，两项试验中心血管死亡终点均有显著差异[EMPA-REG OUTCOME试验：风险比=0.62，置信区间（CI）=0.49-0.77，P<0.001；LEADER试验：风险比=0.78，CI=0.66-0.93，P=0.007]。恩格列净和利拉鲁肽在3年内预防一例心血管死亡所需治疗人数分别为46和77，与目前采用的其他循证心脏保护策略相当。此外，EMPA-REG OUTCOME试验中心力衰竭住院率显著降低（风险比=0.65，CI=0.50-0.85，P=0.002）。
总结
新一代CVOTs正在将T2D治疗的重点转向预防心血管疾病的发病和死亡。
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